SCAI SHOCK: Does the Stage Help with Management Decisions?

No abstract for an Editorial

Lactate Dehydrogenase Rising: Bleeding or Clotting?

Modern continuous-flow ventricular assist devices (VADs) have greatly improved the survival of patients with end stage heart failure. However, they are associated with adverse effects, including cerebrovascular accidents (CVA), bleeding, infection, and device thrombosis. Definitive measures to evaluate for pump thrombosis can be challenging; hence, multiple laboratory and imaging modalities have been studied to help guide decision making. Lactate dehydrogenase (LDH) has proven to be a reliable test when used in the appropriate clinical settings to help diagnose pump thrombosis. When a patient presents with both signs of life-threatening cerebral hemorrhage and VAD thrombosis, the clinical picture can be quite challenging. We present a case with intracerebral hemorrhage that was associated with a significant increase in LDH and created a clinical dilemma since anticoagulation had to be completely reversed in the setting of the bleed. The fact that brain injury (in particular hemorrhage) leads to elevation of LDH is highlighted. Importantly, not all that raises LDH in a ventricular assist patient is thrombosis of the device

Effects of various configurations of vertical slot fishways on fish behaviour in an experimental flume

The knowledge of fish behaviour within vertical slot fishways is limited. This paper describes fish progression through five pools of the 1:4 scale vertical slot fishway of the University of Poitiers (France). Fish behaviour is studied by video monitoring in the third pool of the model. The results are analyzed comparing the number of fish passages between the pools, the stabling zones used by fish in the monitoring pool during their progression and fish trajectories. Comparison of four different pool configurations is performed to estimate the effect of geometric variations on the upstream migration efficiency

Corticosteroid Weaning in Stable Heart Transplant Patients: Guidance by Serum Cortisol Level

Background: Despite earlier studies describing the feasibility of steroid weaning in heart transplant patients, the majority of patients are maintained on steroid therapy for life. We examined a strategy based on a single morning serum cortisol measurement. Methods: We assigned stable posttransplant patients, who were maintained on tacrolimus, mycophenolate mofetil, and corticosteroids, into one of two groups based on a screening morning cortisol level. Patients with a cortisol \u3c 8 micrograms/deciliter were assigned to a maintenance group and the others were assigned to the weaning group and steroids were tapered off over 4-6 weeks. Patients were monitored on subsequent office visits for adrenal insufficiency and allograft rejection. Results: Thirty-one patients were enrolled (6 patients in the maintenance group and 25 in the steroid-weaning group). Mean follow-up was 10.2 ± 4 years for the weaning group and 9.0 ± 4.9 years in the maintenance group (p = 0.6). No cases of rejection were noted, nor did any patient resume steroid treatment following discontinuation. Conclusion: Steroids can be safely discontinued in stable heart transplant patients with an AM serum cortisol ≥ 8 micrograms/deciliter with appropriate outpatient follow-up. In this study, no patient suffered late rejection or clinically noted adrenal insufficiency

Efficiency of Polish metallurgical industry based on data envelopment analysis

The main purpose of this paper is to compare the technical efficiency of 12 sectors manufacturing basic metals and metal products in Poland. This article presents the use of Data Envelopment Analysis models, to determine overall technical efficiency, pure technical efficiency and scale efficiency of metallurgical branches in Poland. The average technical efficiency of metallurgical industry in Poland was quite high. The analysis gives a possibility to create a ranking of sectors. Three branches were found to be fully efficient: manufacture of basic iron and steel and of ferroalloys, manufacture of basic precious and other non - ferrous metals and manufacture of tubes, pipes, hollow profiles and related fittings, of steel. The results point out the reasons of the inefficiency and provide improving directions for the inefficient sectors.Web of Science55224824

Gene expression profiling to study racial differences after heart transplantation.

BackgroundThe basis for increased mortality after heart transplantation in African Americans and other non-Caucasian racial groups is poorly defined. We hypothesized that increased risk of adverse events is driven by biologic factors. To test this hypothesis in the Invasive Monitoring Attenuation through Gene Expression (IMAGE) study, we determined whether the event rate of the primary outcome of acute rejection, graft dysfunction, death, or retransplantation varied by race as a function of calcineurin inhibitor (CNI) levels and gene expression profile (GEP) scores.MethodsWe determined the event rate of the primary outcome, comparing racial groups, stratified by time after transplant. Logistic regression was used to compute the relative risk across racial groups, and linear modeling was used to measure the dependence of CNI levels and GEP score on race.ResultsIn 580 patients monitored for a median of 19 months, the incidence of the primary end point was 18.3% in African Americans, 22.2% in other non-Caucasians, and 8.5% in Caucasians (p < 0.001). There were small but significant correlations of race and tacrolimus trough levels to the GEP score. Tacrolimus levels were similar among the races. Of patients receiving tacrolimus, other non-Caucasians had higher GEP scores than the other racial groups. African American recipients demonstrated a unique decrease in expression of the FLT3 gene in response to higher tacrolimus levels.ConclusionsAfrican Americans and other non-Caucasian heart transplant recipients were 2.5-times to 3-times more likely than Caucasians to experience outcome events in the Invasive Monitoring Attenuation through Gene Expression study. The increased risk of adverse outcomes may be partly due to the biology of the alloimmune response, which is less effectively inhibited at similar tacrolimus levels in minority racial groups

Multi-Feeder Restoration using Multi-Microgrid Formation and Management

This papers highlights the benefit of coordinating resources on mulitple active distribution feeders during severe long duration outages through multi-microgrid formation. A graph-theory based multi-microgrid formation algorithm is developed which is agnostic of the underlying energy management scheme of the microgrids and solved in a rolling horizon fashion. The algorithm is then enhanced to handle multiple feeders where formation of long laterals needs to be avoided due to potential voltage control issues in distribution systems. The algorithm is evaluated on a synthetic two feeder system derived from interconnecting two IEEE 123 node system. The results indicate increased service to loads in the system and better utilization of renewable resources.Comment: Submitted to IEEE PESGM 202